This prospective cohort study evaluated cerebral arteriopathy severity using a modified bilateral Focal Cerebral Arteriopathy Severity Score (FCASS) on MR angiography in 108 adults (age 20–65) with persistent post-COVID headache and/or brain fog (≥15 days/month for ≥3 months) vs. asymptomatic post-COVID controls, recruited at a single center in Taiwan (August 2022–August 2024).
Both anterior- and posterior-FCASS were significantly higher with more symptom categories (anterior-FCASS: combined 6.6 vs. headache 3.6 vs. brain-fog 4.7 vs. control 0.8; posterior-FCASS: combined 5.5 vs. headache 4.2 vs. brain-fog 4.4 vs. control 0.8; all p<0.001). Brain-fog severity correlated with posterior-FCASS (Pearson's r=0.338, p=0.009) but not anterior-FCASS; headache frequency did not correlate with FCASS in either circulation. Pure brain-fog showed more anterior circulation predominance than pure headache (80.8% vs. 48.0%, p=0.020).
- No pre-COVID MRA for comparison, so pre-existing arteriopathy cannot be fully excluded (mitigated by excluding vascular risk factors and age >65). - Single-center matched design; group sizes do not reflect real-world symptom prevalence. - No vessel wall imaging to characterize lesion type (inflammatory vs. vasospastic vs. other).
Consider brain MRA in post-COVID patients with persistent headache or brain fog lasting ≥3 months—even without thunderclap headache—as cerebral arteriopathy (including vasospasm) was found in 28.9% of symptomatic patients. When arteriopathy with vasospasm is identified, calcium channel blockers such as nimodipine may be a reasonable treatment option.
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